Opinions of Brazilian resuscitation instructors regarding resuscitation in the delivery room of extremely preterm newborns

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• 作者：Cristiane Ribeiro Ambró ; sio^a ; ^b ; Maria Fernanda Branco de Almeida^c ; Ruth Guinsburg^c ; ^{ruthgbr@netpoint.com.br" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Newborn infant ; Bioethics ; Resuscitation orders ; Cardiopulmonary resuscitation ; Fetal viability
• 刊名：Jornal de Pediatria
• 出版年：2016
• 出版时间：November-December 2016
• 年：2016
• 卷：92
• 期：6
• 页码：609-615
• 全文大小：465 K

文摘

To describe the opinions of pediatricians who teach resuscitation in Brazil on initiating and limiting the delivery room resuscitation of extremely preterm infants.

Method

Cross-sectional study with electronic questionnaire (Dec/2011–Sep/2013) sent to pediatricians who are instructors of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics, containing three hypothetical clinical cases: (1) decision to start the delivery room resuscitation; (2) limitation of neonatal intensive care after delivery room resuscitation; (3) limitation of advanced resuscitation in the delivery room. For each case, it was requested that the instructor indicate the best management for each gestational age between 23 and 26 weeks. A descriptive analysis was performed.

Results

560 (82%) instructors agreed to participate. Only 9% of the instructors reported the existence of written guidelines at their hospital regarding limitations of delivery room resuscitation. At 23 weeks, 50% of the instructors would initiate delivery room resuscitation procedures. At 26 weeks, 2% would decide based on birth weight and/or presence of fused eyelids. Among the participants, 38% would re-evaluate their delivery room decision and limit the care for 23-week neonates in the neonatal intensive care unit. As for advanced resuscitation, 45% and 4% of the respondents, at 23 and 26 weeks, respectively, would not apply chest compressions and/or medications.

Conclusion

Difficulty can be observed regarding the decision to not resuscitate a preterm infant with 23 weeks of gestational age. At the same time, a small percentage of pediatricians would not resuscitate neonates of unquestionable viability at 26 weeks of gestational age in the delivery room.